We investigated the incidence and prevalence of retinopathy in a sample of 981 middle-aged ARIC study participants who were selected to participate in the third and fourth ARIC study examinations and who had retinal photographs of the same eye taken at both study visits. The prevalence of retinopathy was 7.7%, with 3.8% of people developing signs of retinopathy in the three year interval between exams. Although the rate of retinopathy was found to be higher among diabetics (40 of 147), a comparable number of cases occurred in non-diabetic individuals (36 of 834). Factors found to increase risk of retinopathy include higher levels of blood pressure, fasting serum glucose, total cholesterol, and plasma fibrinogen. (Am J Ophthalmol 2007;143:970-976). We examined 10 year changed in retinal microvascular lesions in a sample of ARIC participants and found that, over a decade, new retinal vessels appeared and a significant proportion disappeared, suggesting considerable remodeling in the retinal microvasculature. (Ophthalmology 2011;118:1612-1618). Measurement of systolic blood pressure and plasma glucose levels monitored over 18 years showed even modest elevations were associated with retinal vessel caliber and retinopathy, and persisted even among persons without diabetes. (Atherosclerosis 2012;225:412-417). Based on the participation of the ARIC cohort in the CHARGE Consortium, several papers have been published on the genetic basis of retinal vessel caliber, retinopathy, and age-related macular degeneration, including PLOS Genetics Oct 2010 e1001184; Jan 2013 e53830; Feb 2013 e54232; and June 2013 e65804. The ARIC study contributed data to an international collaboration conducting a meta-analysis of retinal data. Retinal vascular caliber was found to be a marker of systemic microvascular dysfunction, associated with an increased risk of developing hypertension among people who previously did not have any clinical signs of hypertension, diabetes or cardiovascular disease (J Hypertension 2014;32:307-15). Data from the ARIC study was pooled with data from other studies to investigate whether African ancestry was associated with risk of diabetic retinopathy but no genome-wide locus was found to be significant (Invest Ophthalmol Vis Sci 2015;56:3999-4005). Genes influencing the size of retinal vessels were investigated by an international consortia. Among its findings, a single-nucleotide polymorphism identified was also associated with both systolic and diastolic blood pressure (Circ Cardiovasc Genet 2016;9:45-54). ARIC study data contributed to a meta-analysis which found that people with type 2 diabetes and retinal complications are at higher risk of developing incident cardiovascular disease (JAMA Ophthalomology 2017;135(6):586-593). For more information about the ARIC study, including the full list of investigators and participating institutions and resulting publications, see http://www2.cscc.unc.edu/aric/ http://www.cscc.unc.edu/carmri/. For information on securing access to data, refer to dbGaP (http://www.ncbi.nlm.nih.gov) and BIOPROJECT (https://www.ncbi.nlm.nih.gov/bioproject)